Any rise in temperature is a discomfort.. and above 101F it becomes intolerable... and hence requires treatment.

'Highest level of tolerable temp' has no clinical significance as some children show symptoms of hyperpyrexia even at 103 F. and it varies from person to person.

The question is whether do we need to treat the fever?
fever upto 101F should be watched.. as it may get cured spontaneusly and it can cure the disease at times.

High fever in children, can at times turn lethal; so observing without treatment is no wise.

How do we manage:

1. Switch on Fan /AC, not directed towards pt, air in room should be free flow.
2. take clothes off.. no blankets... a common question always asked is what to do if child is shivering...? The answer is child may shiver.. we may give blanket for 1o min only.. as shivering doesnt last longer and fever starts rising after shiver if a blanket is given. Also shivering is protective while fever may be harmful. SO do take the vlanket off by 10 min... can repeat same.
3. Give an oral antipyretic. In viral infections and malarial fever , the myalgia plays a significant role... so its better to use a combination with ibuprofen or only ibuprofen.. more symptomatic relief. wait for 10 min.
4. Fever coming down : observe. Fever not coming down: start sponging.
5. Sponging tricks : Keep fan on. dont get scared of shivering. Dont use ice or cold water (why? : its not required ! and it has a risk of ppting hypothermia in children.. children are scared of cold when febrile) use a wet hanky /turkish towel, make it wet.. remove excess water.. spread it over the trunk and tummy... cover maximum surface area, faster relief; till it dries off or becomes hot.. then change the towel, repeat same till temp comes down. Forehead sponging: Most of the times not reqd.. as it carries undue emphasis from movies.. and covers small area. Parents may restrict sponging only to forehead. TricK: make scalp wet, let the forehead towel cover eyes.. that avoids pricking sensation in eyes.
6. wait another 10 minutes.. temp same or falling... observer and continue. If temperature rising.. try injectable paracetamol... by this we are just increasing the dose of PCM, changing route is only bcos child wont be in a position to take oral; one may try rectal.. equally effective.
7. Treat the cause of fever !!

Why prompt relief of fever reqd?
Annoying symptom, discomfort, feb seizure... hyperpyrexic brain damage.

Copyrights: dr pediatrician at Sunday, June 05, 2005